Only those doctors who are listed in the healthcare workers' register are allowed to practice medicine in Estonia. While those who studied medicine in Europe are registered automatically, it is significantly more difficult for medical professionals from third countries to obtain the right to work.

"First, we review what kind of education the person has completed. Then they must take an equivalency exam, which is a clinical skills exam. And, of course, language proficiency is a key requirement, since the exam is conducted in Estonian. If they pass it, permission to be listed in the register is granted. But we know that sometimes employers support language studies, and these professionals are not immediately ready to work 100 percent in Estonian," said Külli Friedemann, head of the Health Board's health services department.

Last year, four doctors from Ukraine — all war refugees — passed the equivalency exam at the University of Tartu. Of 16 Ukrainian dentists, 11 were under temporary protection. In the future, more and more Ukrainian family physicians are expected to join the system.

"Family doctors have also come into the field. At the primary care level, there are doctors who must complete residency training and the equivalency exam here, and Ukrainian family doctors have already submitted applications for residency," Friedemann noted.

Doctors from third countries mainly end up working in Virumaa (made up of Ida-Viru and Lääne-Viru counties — ed). At the Ida-Viru Central Hospital, one in five doctors is from abroad, and according to chief physician Pille Letjuka, the hospital cannot rely solely on graduates from the University of Tartu.

"We have around 200 doctors, and 40 of them are from abroad. That's quite a significant portion, so I think we'd have to shut down some specialties if we didn't have these doctors," said Letjuka.

The opportunity to work in Russian is what draws many doctors from third countries to Virumaa, but this makes learning Estonian more difficult.

"I've been here for over 10 years, and I feel I still need to study more. Right now I'm taking Estonian classes three times a week. We're also getting more Estonian-speaking patients now," said Roksolana Goshka, a gynecologist at Ida-Viru Central Hospital.

A few dozen foreign doctors won't be enough to solve Estonia's medical staffing shortages, but the Health Board does not consider easing the Estonian language requirement to be an option.

"The bigger issue is that Estonian patients must be able to receive healthcare services in Estonian, and healthcare workers must understand what Estonian-speaking patients are saying. That's where the real challenges lie," said Friedemann.

According to Friedemann, the ideal scenario is for doctors to speak Estonian at an advanced level, but those with a B2 proficiency level are also allowed to work.

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